Penetrating Gunshot Injury; A Case Image

Penetrating gunshot injury is rare to be seen but it is a life threatening condition whenever it is present. First stabilization of the patient’s vital signs with saline infusion, compression of bleeding sides should be provided. And then transfer to an advanced life support facilities must be the second step. Here we present a 17-years-old female patient who had a penetrating gunshot injury during the ongoing war in Kobani, Syria. The first aid was performed successfully in the field and the patient was admitted to our emergency department with good vital signs. She had a blood pressure of 112/65 mmHg, a pulse rate of 97 bpm, a body temperature of 36.4°C and a respiration of 19 for minute. On the physical examination there was a large scale of bullet entry wound on left breast without any exit wound. The thoraco-abdominal computerized tomography revealed multiple missiles in breast (Figure-1A), one in liver (Figure-1B) and one in the left ventricle (Figure-1C) with left pleural bleeding. Abdominal ultrasonography showed abdominal fluid which was attributed to trauma to liver. Trans-thoracic echocardiography revealed normal left ventricle ejection fraction and valve functions without any pericardial effusion. The patient was referred a tertiary hospital for multidisciplinary approach. There the patient has undergone a successful liver repair operation and tube drainage of pleura. Resection of the missiles from the breast was also performed. Continuous echocardiography was performed for evaluation of cardiac performance and pericardial effusion. Luckily there were no need for cardiac surgery and the patient was discharged without any disability. By presenting this case image we would like to remind a very rare condition; penetration gunshot injury and the management of it. Multidisciplinary approach to casualties like this is crucial for keeping the patients alive.

Penetran Ateşli Silah Yaralanması; Bir Görüntülü Olgu